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ACUTE LYMPHOBLASTIC LEUKEMIA

Impact of bridging chemotherapy on clinical outcome of CD19 CAR T therapy in adult acute lymphoblastic leukemia

Leukemia volume 35, pages 3268–3271 (2021)Cite this article

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To the Editor:

Autologous chimeric antigen receptor (CAR) T cell therapy targeting CD19 is effective in B-cell malignancies such as acute lymphoblastic leukemia (ALL) [1,2,3]. Prior to infusion, T cells must be collected, activated, transduced, expanded, and validated [4]. This creates a “bridging period,” lasting from the decision to treat until T cells are infused, during which patients may experience disease-related complications that delay or prevent CAR T cell infusion. Clinical trials of CD19 CAR T therapy reported high rates of patient dropout after enrollment due to progression of disease (POD) or treatment-related complications [2, 5,6,7,8], which highlights the challenges of clinical management during the bridging period.

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Fig. 1: Overall survival from enrollment (start of bridging) by disease status and response to bridging.
Fig. 2: Comparison of high- and low-intensity bridging strategies.

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  1. These authors contributed equally: Renier J. Brentjens, Jae H. Park

Authors and Affiliations

  1. Department of Medicine, Cellular Therapy Center, New York, NY, USA

    Karlo Perica, Kevin J. Curran, Isabelle Rivere, Xiuyan Wang, Brigitte Senechal, Elizabeth Halton, Claudia Diamonte, John Pineda, Yvette Bernal, Michel Sadelain, Renier J. Brentjens & Jae H. Park

  2. Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Jessica Flynn & Mithat Gonen

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  1. Karlo Perica
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Correspondence to Jae H. Park.

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Conflict of interest

KP discloses patent or royalties (Neximmune, Inc.) and acknowledges funding from NCI (t32-CA009207). KJC discloses consulting or advisory role (Novartis) and research funding (Juno Therapeutics). CD discloses travel accommodations and expenses from Juno Therapeutics. MG discloses consulting or advisory roles with Tesaro. IR discloses stock or ownership interest, consulting or advisory role, research funding, and patents and royalties, all from Juno Therapeutics. MS discloses consulting or advisory role (Juno Therapeutics), research funding (Atara Biotherapeutics; Fate Therapeutics; Juno Therapeutics; Takeda; Takeda; Takeda; Takeda), and patients or royalties (Juno Therapeutics). RB discloses stock and ownership interests, consulting or advisory role, research funding, and patents or royalties, all from Juno Therapeutics. JHP discloses consulting or advisory roles (Adaptive Biotechnologies; Amgen; Kite Pharma; Novartis; Pfizer) and research funding (Genentech/Roche; Juno Therapeutics).

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Perica, K., Flynn, J., Curran, K.J. et al. Impact of bridging chemotherapy on clinical outcome of CD19 CAR T therapy in adult acute lymphoblastic leukemia. Leukemia 35, 3268–3271 (2021). https://doi.org/10.1038/s41375-021-01196-3

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